Saturday, December 19, 2009

Pass MRCP PACES in One Attempt


Pass MRCP PACES in ONE Attempt!


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Besides that, the author also explains 10 MRCP PACES Myths that you shouldn't believe!


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Hope for those who have passed Part 1 and 2. Get this ebook before you enter your exam hall in PACES!

Sunday, December 06, 2009

Bartter's and Gitelman's Syndromes

Bartter's and Gitelman's Syndromes in MRCP

I hate syndromes because I always can't remember them well. My Professor once said, clinicians term something as syndrome when they do not know much about an illness.

Having said that, some syndromes are important for your MRCP,I am going to talk about Bartter's and Gitelman's syndrome.

First fact to remember, Bartter's syndrome is an disorder of transport in the medullary thick ascending limb of Henle.

Second fact to remember, Bartter's syndrome is an illness resembles patients chronically takingloop diuretcs that inhibit activity of Na-K-2Cl co transporter.

Third fact to remember- they do not have hypertension.

So, what will happen to you if you chronically take frusemide?

Easy- you get hypokalemia and alkalosis and hypercalciuria- therefore leading to nephrocalcinosis. You might not be able to explain hypercalciuria but just remember that. Therefore, patients with Bartter's syndrome get hypokalemic metabolic alkalosis. ( as compared to hypokalemic metabolic acidosis in Renal tubular acidosis)



If you are interested to read more about ROMK ( renal outer medullary potassium channel), try to search the net! ( not important in your MRCP!)

As for Gitelman's syndrome, it is an disorder of distal convulated tubule, it is an variant of Bartter's syndome with similar biochemical abnormalities except Gitelman's syndrome has hypocalciuria as compared to hypercalciuria in Bartter's syndrome and hypomagnesimia in Gitelman's syndrome. ( Bartter's syndrome has normal Magnesium Level)

MRCP Past Year Question

A 15-year-old girl is referred to clinic complaining of generalised muscle weakness, fatigue and polyuria. Her blood pressure in clinic is measured at 90/74 mmHg. Investigations:


Serum sodium 127 mmol/l
Serum potassium 3.0 mmol/l
Serum urea 7.2 mmol/l
Serum creatinine 110 umol/l
Serum chloride 92 mmol/l (NR 97-108 mmol/l)
Serum bicarbonate 34 mmol/l (NR 22-28 mmol/l)
82 mmol/l (NR 0.8-1.1 mmol/l)
Urine sodium 160 mmol/l (NR 40-130 mmol/l)
Urine calcium 8.0 mmol/24hr (NR 2.5-8.0 mmol/24hr)
Which of the following is the most likely diagnosis?
Available marks are shown in brackets

1 ) Addison's disease
2 ) Bartter's syndrome
3 ) Laxative abuse
4 ) Liddle's syndrome
5 ) Thiazide diuretic abuse

What is the answer??

Friday, December 04, 2009

How to pass your Part 1 and 2?

How to pass your MRCP Part 1 and 2?

Today I am going to talk something different. No hard facts to learn today, just relax and listen to my 5-cent advice that can help you to pass your MRCP Part 1 and 2.

First of all, I think Part 1 is more difficult to pass because candidates seldom do in basic sciences questions. I will advise you to read more about basic sciences when you sit for your part 1. Anyway, there are a few strategies to pass both your Part 1 and 2.


1) Correct way to study

I must say that the fatest way to remember your facts is trying to answer past years questions. When you try to do these questions, read around the topic and learn more facts about a topic. You will be suprised how fast you can master a topic.

2) Correct books to buy

Buy the correct books to study. It is difficult to tell which book to buy but remember that a good book gives your relevant and important facts to remember not high-end useless not exam-orientated facts!

3) Be systematic and disciplined

You will never pass if you are not disciplined enough, always divide your time, let say you have another 10 months before your exam, divide your time like 1 month to study endocrinology, another month to study respiratory etc. Finish all the topics before your examination!

4) Always discuss with your friends

If you do not understand a topic, always discuss with your friends who are sitting the exam together. You will be suprised how easy he/she might answer your questions. There is an old Chinese saying, when there are 3 persons together, you ceratinly can learn new things from one of them!

5) Answer all your questions

During your exam, answer all your questions, no negative marking, you have 20% chance of get it right even though you know nothing. If you randomly answer 5 questions, you will get one right!!

Hope this piece of informations helps!